Bokma Wicher A, Batelaan Neeltje M, van Balkom Anton J L M, Penninx Brenda W J H
Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZ inGeest, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZ inGeest, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
J Psychosom Res. 2017 Mar;94:10-16. doi: 10.1016/j.jpsychores.2017.01.004. Epub 2017 Jan 6.
Anxiety and/or Depressive Disorders (ADDs) and Chronic Somatic Diseases (CSDs) are associated with substantial levels of health-related disability and work impairment. However, it is unclear whether comorbid ADDs and CSDs additively affect functional outcomes. This paper examines the impact of ADDs, CSDs, and their comorbidity on disability, work absenteeism and presenteeism.
Baseline data from the Netherlands Study of Depression and Anxiety (n=2371) were used. We assessed presence of current ADDs (using psychiatric interviews, CIDI) and presence of self-reported CSDs. Outcome measures were disability scores (WHO-DAS II questionnaire, overall and domain-specific), work absenteeism (≤2weeks and >2weeks; TiC-P) and presenteeism (reduced and impaired work performance; TiC-P). We conducted multivariate regression analyses adjusted for socio-demographics.
Both ADDs and CSDs significantly and independently impact total disability, but the impact was substantially larger for ADDs (main effect unstandardized β=20.1, p<.001) than for CSDs (main effect unstandardized β=3.88, p<.001). There was a positive interaction between ADDs and CSDs on disability (unstandardized β interaction=4.06, p=.004). Although CSDs also induce absenteeism (OR for extended absenteeism=1.42, p=.015) and presenteeism (OR for impaired work performance=1.42, p=.013), associations with ADDs were stronger (OR for extended absenteeism=6.64, p<.001; OR for impaired work performance=7.51, p<.001).
Both CSDs and ADDs cause substantial disability, work absenteeism and presenteeism, but the impact of ADDs far exceeds that of CSDs. CSDs and ADDs interact synergistically on disability, thereby bolstering the current view that patients with physical mental comorbidity (PM-comorbidity) form a severe subgroup with an unfavourable prognosis.
焦虑和/或抑郁障碍（ADDs）与慢性躯体疾病（CSDs）与大量的健康相关残疾和工作能力受损有关。然而，尚不清楚ADDs和CSDs的共病是否会累加影响功能结局。本文研究了ADDs、CSDs及其共病对残疾、旷工和出勤主义的影响。
使用荷兰抑郁与焦虑研究（n = 2371）的基线数据。我们评估了当前ADDs的存在情况（使用精神科访谈，复合性国际诊断访谈表）和自我报告的CSDs的存在情况。结局指标为残疾评分（世界卫生组织残疾评定量表第二版问卷，总体及特定领域）、旷工情况（≤2周和>2周；TiC-P）和出勤主义（工作表现下降和受损；TiC-P）。我们进行了经社会人口统计学因素调整的多变量回归分析。
ADDs和CSDs均对总残疾有显著且独立的影响，但ADDs的影响（主效应未标准化β = 20.1，p <.001）远大于CSDs（主效应未标准化β = 3.88，p <.001）。ADDs和CSDs在残疾方面存在正向交互作用（未标准化β交互作用 = 4.06，p =.004）。虽然CSDs也会导致旷工（长期旷工的比值比 = 1.42，p =.015）和出勤主义（工作表现受损的比值比 = 1.42，p =.013），但与ADDs的关联更强（长期旷工的比值比 = 6.64，p <.001；工作表现受损的比值比 = 7.51，p <.001）。
CSDs和ADDs均会导致严重的残疾、旷工和出勤主义，但ADDs的影响远远超过CSDs。CSDs和ADDs在残疾方面存在协同交互作用，从而支持了当前的观点，即患有身心共病（PM共病）的患者构成了一个预后不良的严重亚组。
